Neonatology Flashcards
What is a cephalhaematoma?
Subperioesteal accumulation of blood, confined within the margins of the skull sutures and usually involves the parietal bone.
How to manage a cephalhaematoma?
Observation. It takes a few weeks to resolve. Do not aspirate/drain. There is an imcreased risk of neonatal jaundice, so keep an eye out for that.
Infant of diabetic mother complications?
LGA, hypoglycemia, hypocalcemia, polycythemia, jaundice, RDS
Macrosomia complications?
Hypoxia, cephalhaematoma, facial nerve injury, clavicular fracture, shoulder dystochia, brachial plexus injury
How to treat hypoglycaemia?
Frequent feeding, if Severe give IV bolus dextrose 10% 2ml/kg
Also give IV fluids: dextrose 10% at 60ml/kg/day
What do you see on CXR of RDS
hypoaeration, diffuse granular reticular pattern (ground glass), air bronchograms, low lung volume, diffuse white out of severe
Investigations for pathological/prolonged jaundice
Bedside: transcutaneous bilirubin, Guthrie heel prick test, urine MC&S
Serum: G6PD, TSH
Blood: serum bilirubin, FBC, PBF, reticulocyte, blood group, direct antibody test, Coombs test, UEC, LFT, TFT, septic workup if infection suspected
When does a baby with jaundice need exchange transfusion
Severely elevated serum bilirubin > 20mg/dl or 349 micromol/l
Ddx for RDS
GBS pneumonia, TTN, MAS, congenital lobar emphysema
How to manage RDS
Admit to NICU
Maintain airway and monitor O2
Administer surfactant via ETT
Ventilation:
- O2 therapy
- intubation and intermittent PPV if bradycardic, FiO2 > 40%, severe recurrent apnea, resp failure)
- oral feeding if tolerated otherwise IV fluids and TPN If not feeding after 72 hrs
- IV bicarbonate if metabolic acidosis
- empirical antibiotics till blood cultures negative, gentamicin + penicilllin
Features of ABO incompatibility
- infants Hb normal or slightly decreased
- no hepatosplenomegaly
- Coombs test positive
- jaundice peaks in first 12-72 hours, severe
Managing Rh incompatibility
Regular ultrasound to detect anemia via Doppler of MCA
Might need regular blood transfusions via umbilical vein from 20 weeks
How to manage humerus/femur fracture at birth
Immobilize, will heal fast
How to manage nerve palsies like brachial and erb’s
Most resolve on their own, but if still present at 2-3 months refer to Ortho/plastic surgeon. Most Will resolve at 2 years
Managing facial nerve palsy
Methylcellulose might be needed for the eye, but otherwise transient
Unilateral facial weakness on crying but eye remains open
Tests for neonatal sepsis
Urinalysis + MC&S FBC, ESR, CRP 3xBlood cultures CXR LP
Management for neonatal sepsis
Admit Do septic workup if indicated Monitor FBG and VBG Empiric antibiotics - early onset: benpen + gentamicin - late onset: flucloxacillin + gentamicin unless CNS infection, then cefotaxime Duration of antibiotics - 7-10 days for pneumonia or proven sepsis - 14 days for GBS meningitis - 21 days for Gram-ve meningitis
when does early onset sepsis present
Within 72 hours
Early Complications of very preterm babies or LBW babies
Respiratory: RDS, apnoea and bradycardia (managed by respiratory stimulants, CPAP)
Hepatic: hypoglycemia, hyperbilirubinemia, hyperglycemia
Renal: Hyponatremia, hyperkalemia, metabolic acidosis
Cardiac: PDA
GIT: Feeding problems (manage via IV nutrition, then slowly intro BF), NEC
Neuro: intraventricular hemorrhage (within 72 hours, so must do ultrasound and measure head circ), periventricular leukomalacia (risk of spastic Diplegia, cog impairment)
MSK: rickets
Other: IDA, infection, hypothermia (large surface area, thin skin, less subcut fat)
Late complications of very preterm or LBW infants
Delayed growth - don’t grow for 2-3 weeks post birth, catch up in first 2 years
BPD - chronic lung dx, need supplemental o2 at 37 weeks PGA
Retinopathy of prematurity - disruption of vascularisation of retina causes fibrous scarring and detachment if severely, need laser therapy)
Neurodevelopmental delay - CP, mental retardation, blindness or deafness
Hearing impairment, inguinal hernia
How to manage preterm infants (in NICU)
Admit to NICU
Monitor vitals, cardioresp and SaO2
Monitor with EEG
Monitor for hypoglycemia and electrolyte imbalance
Monitor in incubator and thermoreg functions 4 hrly
Put baby on resp support and maintain SpO2 between 89% to 95%
- CPAP if baby have apnoea
Intermittent skin to skin care
Establish feeding of baby within 90 mins of birth, offer feeding every 3 hours (if not possible, IV nutrition)
Document baby’s urine and stool output, colour, frequency
Discharge when:
- baby maintains temperature
- feeding well, weight gain of 3g or more a day
- appropriate ikmmunization and metabolic screen done
- fundoscopy and hearing evaluation done
Arrange for home-nursing visits
Stabilizing preterm/sick infants
Airway, breathing: clear airway, oxygen/high-flow humidified oxygen/CPAP, mechanical ventilation
Monitoring: Sa02, vitals, blood glucose, blood gases, weight
Temp control: place in plastic bag if extremely preterm otherwise in incubator
Peripheral IV line: for IV fluids, antibiotics etc
Umbilical venous catheter: if extremely preterm/for high-conc dextrose/inotropes
Arterial line: if frequent blood gas analysis, blood test, continuous Bp monitoring
Central venous line if indicated
CXR
IX: FBC, BUSE, creat, lactate, blood culture + csf + urine, blood glucose, CRP, coag if indicated
Broad-spectrum antibiotics
Minimal handling and analgesia
Parents
Clinical diagnosis of hypoxic-ischemic encephalopathy
- cardiorespiratory and neurological depression
- evidence of acute hypoxic compromise with acidemia, arterial cord blood ph < 7 and base excess > - 12mmol/L
HIE multi-organ dysfunction
Encephalopathy: abnormal neuro signs, seizures
Respiratory: persistent pulmonary hypertension of the newborn
Cardio: hypotension
Metabolic: hypoglycemia, hypocalcemia, hyponatremia
Others: DIVC, renal failure
Birth asphyxia If
- evidence of severe hypoxia antenatally, during labour or at delivery
- neonatal resus needed
- encephalopathy features
- characteristic neuroimaging findings
- evidence of hypoxia damage to other organs like liver, kidney, heart
- no other prenatal/postnatal cause identified
Monitoring for prolonged jaundice
Must screen all babies at day 14 if term, day 21 if preterm and tests as before
Jaundice level in infants
> 85 micromol/l (5mg/dl)
